NPIMap

Individual provider Active NPI

Alan B Ettinger, MD

  • Neurology Physician
  • Commack, NY
National Provider Identifier
1467432625
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
169005 Issued in NY
Practice address
6080 Jericho Tpke
Commack, NY 11725-2850
Phone
(631) 364-9119
NPI assigned
Jan 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neurophysiology Physician 2084N0600X 169005 NY
Neurology Physician 2084N0400X 169005 NY Primary

Addresses

Primary practice location

6080 Jericho Tpke
Commack, NY 11725-2850

Mailing address

6080 Jericho Tpke
Commack, NY 11725-2850
Phone (631) 364-9119

Other identifiers 1

IdentifierTypeStateIssuer
01346749MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041222000438 NY Practitioner - NeurologyPractitioner - Neuropsychiatry 1052379088 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Neuropsychiatry
Education
Boston University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
True North Medical at North Suffolk, PLLCGroup PAC ID 0345618088, 19 clinicians

Practice addresses (Care Compare)

Dix Hills, NY 11746
Phone (631) 974-7236

6080 Jericho Tpke
Commack, NY 11725-2850
Phone (631) 364-9119

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Long Island Jewish Health Care Inc CurrentSince Mar 1, 2006 Accepting new patients
North Shore Long Island Jewish Healthcare CurrentSince Mar 1, 2006 Accepting new patients
True North Medical at North Suffolk PLLC Neurology CurrentSince Nov 1, 2022 Accepting new patients
Doctor on Demand Professionals P C CurrentSince Apr 6, 2025 Accepting new patients
Ettinger Medical Services PLLC Neurology CurrentSince Jan 1, 2023 Accepting new patients
NSPC Plastics PastSince Jan 6, 2011 Accepting new patients
New York Medical Monitoring PC Past Accepting new patients

Locations

50 Weston St
Hartford, CT 06120
Phone (855) 522-7233

6080 Jericho Tpke
Commack, NY 11725
Phone (631) 462-2200

6080 Jericho Tpke
Ste 100
Commack, NY 11725
Phone (631) 364-9119

611 Northern Blvd
Great Neck, NY 11021
Phone (516) 325-7000

270 Park Ave
Huntington, NY 11743
Phone (631) 351-2308

27005 76th Ave
North New Hyde Pk, NY 11040

300 Community Dr
Plandome, NY 11030

1010 Route 112
Ste 300
Port Jefferson Station, NY 11776
Phone (631) 364-9119

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1467432625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6080 JERICHO TPKE",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252850",
            "telephone_number": "631-364-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6080 JERICHO TPKE",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252850",
            "telephone_number": "631-364-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTINGER",
        "first_name": "ALAN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-21",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "NY",
            "license": "169005",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "169005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01346749",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Commack, NY

Sources for this page

Verify at the official NPI Registry.